The prevalence of voiding difficulty after TVT,its impact on quality of life,and related risk factors

Objective: To determine the prevalence of voiding difficulty (VD), quality of life, and related risk factors after tension-free vaginal tape (TVT). Design: Prospective cohort study in 703 women with a TVT procedure for stress urinary incontinence. Main outcome measures: VD stated by women, Urogenital Distress Inventory (UDI-6) question 5 (difficulty in emptying the bladder), maximum flow rate, postvoid residual urine, necessity of postoperative catheterization, tape division, and impact on quality of life (Incontinence Impact Questionnaire, IIQ-7). Results: Postoperative catheterization (>24 h) was necessary in 11% and tape division in 1.3% of patients. There were 26% of women who stated VD and 25% reported moderate to great impairment on the UDI-6 after 36 months. While the negative impact on the outcome of TVT in women with abnormal voiding compared to women without is higher, the impact decreased significantly after TVT, implying a considerable improvement in quality of life. Pre-operative existing voiding difficulty and concomitant prolapse surgery were independent risk factors. Conclusions: Symptoms of VD occurred after TVT and caused lesser improvement in quality of life.     

α受体激动剂盐酸米多君治疗女性压力性尿失禁的临床研究

目的　评价盐酸米多君 (管通 )治疗女性压力性尿失禁的有效性和安全性。　方法　采用多中心、随机、双盲、安慰剂平行对照方法对 136例女性压力性尿失禁患者进行管通与安慰剂的对比研究。试验组 6 8例 ,服管通 2 .5mg/次 ,3次 /d ,疗程 4周 ;对照组 6 8例 ,以安慰剂替代管通。 　结果　完成试验 12 9例 ,,管通组 (6 6例 )平均尿失禁量减少 9.9g ,安慰剂组 (6 3例 )减少 3.1g ;管通组尿失禁等级评分减少 1.0 2分 ,安慰剂组减少 0 .35分 ;管通组的客观有效率和主观有效率分别为 6 6 .7%和 80 .3% ,安慰剂组分别为 31.7%和 33.3% ,两组比较 ,差异均有显著性意义 (P均 <0 .0 0 1)。管通组患者副作用发生率 15 .0 % ,安慰剂组 17.1% ,两组间差异无显著性意义 (P >0 .0 5 )。　结论　盐酸米多君治疗女性压力性尿失禁疗效明显 ,优于安慰剂 ,安全性和耐受性与安慰剂相似。     

The effect of catheter diameter on the urethral cough pressure profile of continent and incontinent patients

The importance of catheter diameter in causing inaccurate urethral pressure profile recordings was assessed with the aid of a special, dual diameter catheter. Cough pressure profiles obtained in premenopausal and postmenopausal incontinent patients were compared with control groups. The urethral functional length (FL) and pressure transmission ratio (PTR) did not change. The maximal urethral closing pressure (MUCP) decreased with the smaller catheter only in incontinent patients. Similarly, a decreased urethral surface at rest (USR) was observed for incontinent groups. Continent patients showed no modification of MUCP or USR with change in catheter diameter. The occlusive effect of the catheter was high (21 cmH₂O) in incontinent patients and less in continent patients (5 cmH₂O). The part played by the occlusive effect of the catheter may therefore be evaluated and considered an element explaining artificially high MUCP that do not reflect clinical reality in certain patients. This occurs most often in incontinent patients due to curvature of the catheter during coughing.     

TVT-O和TVT治疗单纯女性压力性尿失禁的疗效对比:立足随机对照试验的Meta分析

目的:系统评价经阴道无张力尿道中段悬吊带术(闭孔路径)(TVT-O)和经阴道无张力尿道中段悬吊带术(TVT)治疗女性压力性尿失禁的客观成功率和并发症发生率。方法:计算机配合手工检索1994年1月~2007年6月各数据库和灰色文献中TVT-O和TVT疗效的随机对照试验(RCT),用Revman4.2.2软件,对两种术式的客观成功率、并发症发生率进行Meta分析。结果:共纳入10个随机对照试验。TVT-O组553例,TVT组575例。Meta分析显示,TVT-O客观成功率、主观成功率均与TVT相似[P>0.05,OR 0.78,95%可信区间(CI):0.47~1.30;P>0.05,OR 0.93,95%CI:0.51~1.68)],TVT-O的"膀胱损伤"发生率低于TVT(P<0.01,OR 0.16,95%CI:0.05~0.49),TVT-O的"尿路症状"发生率与TVT相似(P>0.05,OR 0.90,95%CI:0.61~1.34)。因文献的异质性和结论的高敏感性,不能确定TVT-O"术后疼痛"发生率是否增高。结论:TVT-O术是一种疗效确切的无张力阴道吊带术,与TVT术的成功率、尿路症状相似而膀胱损伤的风险减少。但须进一步研究确证"术后疼痛"发生率是否增加。     

Neurovesical Dysfunction in Postural Tachycardia Syndrome (POTS)

This is the first report of neurovesical dysfunction in a woman with postural tachycardia syndrome (POTS). The patient had both symptoms and urodynamic findings diagnostic of detrusor hyperreflexia. Management consisted of anticholinergic medication and timed voiding. Lower urinary tract dysfunction may be underrecognized in POTS.     

Familial tranmission of genitovaginal prolapse

Some females with little to no risk factors develop prolapse, while other females with multiple risk factors do not. It appears that some women may have a predisposition for prolapse in the setting of equivalent risk factors. We identified 10 patients younger than 55 years old with a family history of prolapse. Their average age was 37 years (range 27–51), the mean number of deliveries was 1.8, and their mean birth weight was 8 lbs. Genetic analysis of the inheritance pattern within these families demonstrated that pelvic organ prolapse segregated in a dominant fashion with incomplete penetrance in these families. Both maternal and paternal transmissions were observed. The relative risk to siblings of affected patients was five times that of the risk for the general population. Further investigation of these families may identify a genetic defect responsible for prolapse.     

Surgical treatment of stress urinary incontinence after radical hysterectomy

Stress urinary incontinence is not infrequent after radical hysterectomy for cervical cancer. Eight women who underwent surgery for correction of stress incontinence after radical hysterectomy were studied with urodynamic techniques before and 1 year after incontinence surgery. Five patients underwent a Marshall-Marchetti-Krantz (MMK) operation, 1 a Burch colposuspension, 1 a sling procedure and 1 an anterior repair. Two patients remained incontinent after an MMK operation, as did the patient who had an anterior repair. The patient who underwent a sling procedure had to practice intermittent selfcatheterization. We conclude that an appropriate operation can cure stress incontinence after radical hysterectomy, but that patients should be selected carefully.     

Epidermoid tumor of the cauda equina presenting with urinary stress incontinence

Spinal cord tumors are a rare cause of urinary incontinence. Tumors of the spinal cord usually present with pain, not with isolated urinary complaints. We report a case in which a patient with an epidermoid tumor of the cauda equina presented initially to a gynecologist complaining of urinary incontinence and pelvic relaxation symptoms. Failure to appreciate the neurologic signs on physical examination may have led to a delay in diagnosis and inappropriate management of the patient.     

Clinical observation on electroacupuncture against urinary incontinence

Urinary incontinence is a common problem, usually classified as stress incontinence or urge incontinence. With the development of medical science, people have got more and more profound knowledge towards urinary incontinence. We treated urinary incontinence with electroacupuncture since 2006, and now reported it as follows.     

盆底肌电刺激在女性尿失禁治疗中的应用

目的 探讨盆底肌电刺激对女性尿失禁的作用机制及疗效。方法 对43例女性尿失禁患者应用盆底肌电刺激治疗，电极探头置于阴道中部，在不同的电流状态下，间歇刺激阴部神经。结果 尿失禁患者渗、漏尿事件减少46％，尿频次数减少49％，24h内排尿次数在10～12次之间；患者的总主观改善率为68％，总客观改善率为74％。结论 盆底肌电刺激对女性尿失禁有明显疗效，能提高患者生活质量。